Management of Infertility in Females

Dr. Umesh N. Jindal

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More than two decades have passed since the birth of Louise Joe Brown in the United Kingdom as a result of the first successful In-Vitro-Fertilization (IVF). Intensive research and innovations in culture techniques, medical and surgical management of infertility have revolutionized the outlook for the infertile couples. Now it is possible to offer treatment to 90% – 95% of couples with success rates varying between 20% – 80% for various modalities of treatment.

Infertility affects men and women of reproductive age worldwide causing considerable personal suffering and disruption of family life. Although estimates of prevalence are not very accurate and also vary from region to region, almost 8% – 10% of couples experience some form of infertility problem during their reproductive lives.

Definition

Infertility is defined as the inability to conceive for at least one year of unprotected intercourse. Treatment may be started early in case of an obvious cause or advanced age of couple. Primary infertility refers to no conception ever in the past while secondary infertility is labeled if there has been a conception irrespective of the outcome of that pregnancy.

Etiology and Diagnosis

Accurate diagnosis is the key to successful treatment. The dictum holds true for infertility as for any other problem in medicine but is often overlooked. At the level of an individual couple, assessment of the cause is often difficult and time consuming. Various factors, which contribute to infertility, can be generally identified following a full and comprehensive investigation of both partners; it is often difficult to attribute infertility to a single factor.

Infection related problems in both males and females are more common in developing countries with poor socio-economic strata. In developed countries and in higher socio-economic groups, major chunk is constituted by ovulatory dysfunction, advanced maternal age, endometriosis and no demonstrable cause.

Distribution of causes between male and female is generally equally divided. The oft quoted rough estimate of causes between partners i.e. 30% female, 30% male, 30% both and the rest idiopathic has generally been vindicated in most of the studies.

There is a well-defined set of investigations to be followed to assess various factors contributing to a couple’s infertility. Detection of one cause does not rule out the presence of other causes since multifactorial infertility is very common. Both partners must be investigated simultaneously and completely, as problem in one partner does not rule out another problem in the other partner. The plan of action must be individualized for every couple after a thorough discussion with the couple. Various factors which influence decision making such as age, duration and type of infertility, likely cause, cost and time involved, social and psychological pressure etc. should be considered.